The Retrograde Approach of Surgical Paddle-Lead Placement for Spinal Cord Stimulation

Area of Science:

• Neurosurgery
• Pain Management
• Spinal Surgery

Background:

• Standard anterograde placement of surgical paddle leads (SPLs) for spinal cord stimulation (SCS) can be challenging due to prior surgery, instrumentation, or severe stenosis.
• Retrograde (caudal) insertion via cephalad laminotomies is a less-documented alternative technique.

Purpose of the Study:

• To present the authors' ten-year experience with retrograde insertion of SPLs for SCS.
• To evaluate the feasibility and safety of the retrograde approach.

Main Methods:

• Retrospective study of 298 consecutive surgical paddle implants performed by a single neurosurgeon from 2013 to 2023.
• Analysis of 26 patients who underwent retrograde SPL insertion.

Main Results:

• The retrograde approach was planned preoperatively in 96% of cases for 26 patients (average age 61, 58% female).
• Indications included prior SCS lead scarring (46%), extensive spine surgery scarring (42%), anatomical considerations (8%), or intraoperative findings (4%).
• Most implants targeted the thoracic spine (88%); one case of lead migration required revision, with no paddle-lead fractures or deep infections.

Conclusions:

• Retrograde insertion of SPLs is a low-risk, feasible procedure for SCS.
• The technique minimizes risks of lead migration, fracture, and deep surgical site infection, suitable for trials and permanent placements.